{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T23:55:37Z","timestamp":1778025337430,"version":"3.51.4"},"reference-count":46,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JEMR"],"abstract":"<jats:p>(1) Background: This study investigates the impact of digital device usage on the visual system, with a focus on binocular vision. It also highlights the importance of objective assessment in accurately diagnosing and guiding therapeutic approaches for Digital Eye Strain Syndrome (DESS). (2) Methods: A comprehensive narrative review was conducted to synthesize existing evidence. The methodological quality of observational and case\u2013control studies was assessed using the Newcastle\u2013Ottawa scale, while randomized controlled trials (RCTs) were evaluated using the Cochrane risk-of-bias (RoB 2) tool. (3) Results: Fifteen articles were included in this review, with a predominant focus on binocular vision anomalies, particularly accommodative and vergence dysfunctions, as well as ocular surface anomalies related to DESS. Clinical assessments relied primarily on symptom-based questionnaires, which represent a significant limitation. The included studies were largely observational, with a lack of longitudinal and RCTs. In contrast, research in dry eye disease has been more comprehensive, with multiple RCTs already conducted. (4) Therefore, it is essential to develop validated objective metrics that support accurate clinical diagnosis and guide evidence-based interventions. Conclusions: It remains unclear whether changes in binocular vision are a cause or consequence of DESS. However, prolonged screen time can exacerbate pre-existing binocular vision anomalies due to continuous strain on convergence and accommodation, leading to symptoms. Future research should prioritize prospective longitudinal studies and well-designed RCTs that integrate objective clinical measures to elucidate causal relationships and improve diagnostic and therapeutic frameworks.<\/jats:p>","DOI":"10.3390\/jemr18050039","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T12:18:18Z","timestamp":1757074698000},"page":"39","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Review of Digital Eye Strain: Binocular Vision Anomalies, Ocular Surface Changes, and the Need for Objective Assessment"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0889-4809","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Barata","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"},{"name":"Institute for Research and Advanced Training, University of Evora, 7004-516 Evora, Portugal"},{"name":"Department of Therapy and Rehabilitation Sciences, Escola Superior de Tecnologia da Sa\u00fade de Lisboa (ESTeSL), Instituto Polit\u00e9cnico de Lisboa, 1990-096 Lisbon, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), Escola Nacional de Sa\u00fade P\u00fablica, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-7732","authenticated-orcid":false,"given":"Pedro","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Comprehensive Health Research Centre (CHRC), Escola Nacional de Sa\u00fade P\u00fablica, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal"},{"name":"Department of Health Strategies, National School of Public Health, NOVA University of Lisbon, 1600-560 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3724-2391","authenticated-orcid":false,"given":"Andrzej","family":"Grzybowski","sequence":"additional","affiliation":[{"name":"Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-701 Poznan, Poland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0320-1839","authenticated-orcid":false,"given":"Andr\u00e9","family":"Moreira-Ros\u00e1rio","sequence":"additional","affiliation":[{"name":"Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"},{"name":"NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9918-787X","authenticated-orcid":false,"given":"Carla","family":"Lan\u00e7a","sequence":"additional","affiliation":[{"name":"Comprehensive Health Research Centre (CHRC), Escola Nacional de Sa\u00fade P\u00fablica, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal"},{"name":"Division of Science, New York University Abu Dhabi, Saadiyat Marina District, Abu Dhabi P.O. Box 129188, United Arab Emirates"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sheppard, A.L., and Wolffsohn, J.S. (2018). Digital eye strain: Prevalence, measurement and amelioration. BMJ Open Ophthalmol., 3.","DOI":"10.1136\/bmjophth-2018-000146"},{"key":"ref_2","unstructured":"Nolasco, J. (2016). Manual De Ergoftalmologia, Sociedade Portuguesa de Oftalmologia. Available online: https:\/\/spoftalmologia.pt\/wp-content\/uploads\/2016\/12\/MANUAL-DE-ERGOFTALMOLOGIA.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Abusamak, M., Jaber, H.M., and Alrawashdeh, H.M. (2022). The Effect of Lockdown Due to the COVID-19 Pandemic on Digital Eye Strain Symptoms Among the General Population: A Cross-Sectional Survey. Front. 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